Provider Demographics
NPI:1265468847
Name:DRS. C. ROZDEBA & M. LUPINSKA, LLC
Entity Type:Organization
Organization Name:DRS. C. ROZDEBA & M. LUPINSKA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHA
Authorized Official - Middle Name:H
Authorized Official - Last Name:ROZDEBA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-777-0090
Mailing Address - Street 1:42 LOCUST AVE
Mailing Address - Street 2:
Mailing Address - City:WALLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07057-1300
Mailing Address - Country:US
Mailing Address - Phone:973-777-0090
Mailing Address - Fax:973-777-9424
Practice Address - Street 1:42 LOCUST AVE
Practice Address - Street 2:
Practice Address - City:WALLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07057-1300
Practice Address - Country:US
Practice Address - Phone:973-777-0090
Practice Address - Fax:973-777-9424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA041891002080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1396791778OtherNPI
NJ1013963032OtherNPI
NJ=========OtherTAX ID